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City of Prior Lake
Sump Pump and I/I Reduction
Inspection Form ~,~,~~
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Name: ~~~~~~s ~i~,~ ~ C.JC~ Date~~vn' ~~ TimeX~Qa.m./p.m.
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~r ~ '/ ~~~First In~sp~ on ~E3" Second ~
Address:~~~/~~1.+J~~~(/,Q Vf•E~~c~ /~(~ Own: L~" Rent: - Age of Home: ~
Residential:
ry ~
Prior ~ake, MN 55~1~ Phon~~~~~~~' Non-Residential: ~
A. BASEMENT L'1'~i'es ~ SiTMP BA5KE ~~ ~I~1 L7 2~ 3 ~
WATER IN BASKET es ~ No SiJMP P ~'0 ~1 1 Q 2~ ~~''~
WATER IN BASEMENT (flow over floor) ~ Yes o CI5TERN ~ Yes 9'No
(If no pump, place sticker across edge of sump cover and basement floor so any removal of cover will
break seal. Skip to Part B of this form.)
Discharge Point a Laundry tub ~ Sanitary sewer ~ Outside
at Inspection: ~ Floor drain ~ Other ~"'~-
1
Prior to Inspection: 1
When as system installed, or most recently modified? (.Date) and why
Home came with system ~ Response to inspection program ~ Other
a Water in basement ~ Prev' s system failed
B. ROOF LEADER5: D" Yes Q N DISCHARGE: ~ Near Awa
Y
C. YARD DRAINS Q Yes ~~ WINDOW WELLS Q Yes'~-7'No
BEAVER SYSTEM ~ Yes L~7''No
D. PROPERTIES WITH SUMP PUMPS
When does pump run? ~ Fall ~ Summer
(check all that apply) How often does pump run?
V~here does pump discharge to outside? ~ Front
NOTES:
a Spri~ ~ Winter
~ Back..-- ~ Side
SUMP PUMP SYSTEM: L~3''~ASS ~ FAIL You have 30 days to bring your system into compliance with curre -
regulations. When you are ready for reinspection, ca11651/644-1469,for an rntment.
Is there another place where clear water enters the sanitary sewer system? a Yes No
Where is this location?
This area will need to ixec~ the clear~vate~scharges to the storm sewer system.
Inspector:
Resident:
Date: '~/~- ~G' -
Date: - /o -
Disclaimer: This visual inspection is done with due diligence to find obvious clear water cross-connections
and does not imply the structure meets all City Codes.
White: Homeowner Yellow: City Pink: HRG